Actuación de enfermería en el infarto cerebral agudo / Nursing performance in acute cerebral stroke

La enfermedad vascular cerebral (EVC) es una patología caracterizada por un déficit neurológico súbito, secundario a oclusión o ruptura de un vaso sanguíneo cerebral; se divide en isquémica o infarto cerebral (IC) y hemorrágica. La EVC es reconocida como la primera causa de discapacidad y la quinta causa de muerte en México, registrándose cerca de 170 mil casos nuevos al año. Existe amplia evidencia que demuestra una reducción en los desenlaces negativos, como muerte y discapacidad, al realizar intervenciones rápidas, incluyendo la administración de trombolisis intravenosa con rt-PA (activador tisular de plasminógeno recombinante) y trombectomía mecánica. La coordinación multidisciplinaria del equipo de salud y los cuidados efectivos de enfermería, son vitales durante todas las etapas de atención de la EVC. Esta revisión da a conocer un panorama general del manejo del infarto cerebral e identificar las intervenciones indispensables del profesional de enfermería realiza durante las etapas prehospitalarias, pretrombolisis, durante trombolisis y postrombolisis.

Cerebralvascular disease (CVD) is a pathology characterized by a sudden neurological deficit secondary to occlusion or rupture of a cerebral blood vessel; it is divided into ischemic or cerebral infarction (CI) and hemorrhagic. CVD is recognized as the first cause of disability and the fifth cause of death in Mexico, with nearly 170,000 new cases registered each year. There is ample evidence that shows a reduction in negative outcomes, such as death and disability, with rapid interventions, including the administration of intravenous thrombolysis with rt-PA (recombinant tissue plasminogen activator) and mechanical thrombectomy. Multidisciplinary coordination of the health care team and effective nursing care are vital during all stages of CVD care. This review provides an overview of the management of cerebral infarction and identifies essential nursing interventions during the prehospital, prethrombolysis, during thrombolysis, and postthrombolysis stages.

Factores de riesgo asociado a la infección por SARS-CoV-entre los profesionales sanitarios de España / Risk factors associated with SARS-CoV-2 infection among health professionals in Spain

Fundamento: Las tasas de contagio ocupacional porSARS-CoV-2 entre profesionales sanitarios en España sonelevadas respecto a otros países. El objetivo del estudio fuedescribir y analizar los factores de riesgo asociados a estatransmisión. Material y métodos: Estudio transversal con muestreo noprobabilístico en bola de nieve de profesionales sanitarios(medicina, enfermería, fisioterapia, cuidados auxiliares) dediferentes niveles asistenciales (atención primaria, hospitalaria, sociosanitaria u otra), en contacto o no con pacientescon COVID-19 en junio de 2020 en España. Se elaboró unaencuesta electrónica de 81 preguntas estructurada en cuatro bloques: variables sociodemográficas, conocimientossobre COVID-19, disponibilidad y uso de equipos de protección individual (EPI), y medidas de protección del entornoy formación recibida. Resultados: Respondieron 855 sanitarios, 81,5% mujeres,edad media 44años (28-68). El 93,4% conocía los principalessíntomas pero el 40,4% no identificó la vía transmisión por gotas y contacto. El 67,5% atendieron a pacientes con COVID-19sin EPI adecuado y el 29,1% usó el mismo EPI de manera continuada más de 4 horas. El 25,6% no había recibido formaciónsobre colocación y retirada del EPI y el 61,2% no pudo practicar previamente el proceso. El 19,4% sufrió infección porcoronavirus, más frecuente en profesionales que no habíanrecibido formación específica (25,8 vs 17,2%, p = 0,009). Conclusión: Como estrategias de prevención de contagiose deben implementar la formación, redactar protocolos yprogramas de cribado, supervisar las situaciones de mayorriesgo, asegurar la disponibilidad de material, y aumentarel compromiso de las instituciones sanitarias para apoyaral personal sanitario.(AU)

Background: Occupational infection rates for SARS-CoV-2among health professionals in Spain are high in comparison to other countries. The objective of the study was todescribe and analyze the risk factors associated with thistransmission. Methods: Cross-sectional study with non-probabilisticsnowball sampling of health professionals (medicine, nursing, physiotherapy, auxiliary care) of different levels ofcare (primary care, hospital, nursing homes, etc.), whowere in contact or not with patients with COVID-19, inJune 2020 in Spain. We prepared an electronic survey of81 questions structured in four blocks: sociodemographicvariables, knowledge about COVID-19, availability and useof personal protective equipment (PPE), and environmentalprotection measures and training received. Results: 855 health workers responded, 81.5% women and themean age was 44 years (28-68). 93.4% knew the main symptoms but 40.4% did not identify the route of transmission viadroplets and contact. 67.5% of them cared for COVID-19 patients without adequate PPE and 29.1% wore the same PPEcontinuously for more than 4 hours. 25.6% of workers had notreceived any type of training in donning and removing thePPE and 61.2% of them were unable to previously practicethe process. The frequency of coronavirus infection amonghealth professionals was 19.4%, which is higher in thoseprofessionals who had not received specific training (25.8 vs17.2%, p = 0.009). Conclusion: Training, drafting protocols and screening programs, supervising the situations of greatest risk, ensuringthe availability of material and increasing the commitmentof health institutions to support health personnel should beimplemented as contagion prevention strategies.(AU)

[Risk factors associated with SARS-CoV-2 infection among health professionals in Spain].

BACKGROUND: Occupational infection rates for SARS-CoV-2 among health professionals in Spain are high in comparison to other countries. The objective of the study was to describe and analyze the risk factors associated with this transmission. METHODS: Cross-sectional study with non-probabilistic snowball sampling of health professionals (medicine, nursing, physiotherapy, auxiliary care) of different levels of care (primary care, hospital, nursing homes, etc.), who were in contact or not with patients with COVID-19, in June 2020 in Spain. We prepared an electronic survey of 81 questions structured in four blocks: sociodemographic variables, knowledge about COVID-19, availability and use of personal protective equipment (PPE), and environmental protection measures and training received. RESULTS: 855 health workers responded, 81.5% women and the mean age was 44 years (28-68). 93.4% knew the main symptoms but 40.4% did not identify the route of transmission via droplets and contact. 67.5% of them cared for COVID-19 patients without adequate PPE and 29.1% wore the same PPE continuously for more than 4 hours. 25.6% of workers had not received any type of training in donning and removing the PPE and 61.2% of them were unable to previously practice the process. The frequency of coronavirus infection among health professionals was 19.4%, which is higher in those professionals who had not received specific training (25.8 vs 17.2%, p=0.009). CONCLUSION: Training, drafting protocols and screening programs, supervising the situations of greatest risk, ensuring the availability of material and increasing the commitment of health institutions to support health personnel should be implemented as contagion prevention strategies.

Atención del paciente con EPOC mediante un programa de e-salud / E-health for copd patients

La e-salud, apoyada en el uso de las nuevas tecnologías, nos da las herramientas necesarias para innovar en la asistencia a nuestros pacientes y ha permitido evolucionar el concepto de la relación profesional sanitario-paciente. Sus aplicaciones son prácticamente ilimitadas y los estudios avalan su eficacia, si bien, existen una serie de cuestiones que limitan su implementación real (dificultad para la comparación metodológica, factores asociados al profesional o al paciente, aspectos éticos y legales, etc.). Una de las aplicaciones más interesantes desde el punto de vista clínico es la tele-consulta, especialmente en la actual situación de pandemia por la COVID-19. En este trabajo revisamos las posibilidades de implementación de un programa de tele-consultas en pacientes con EPOC, la selección de candidatos, las posibles herramientas tecnológicas y las limitaciones de este tipo de programas (AU)

E-health using new technologies is a new way to attend our patients and creates a new scenario in the relation between patients and their health carers. Their applications are uncontable and many articles support their efficacy, although some questions still make difficult its implementation. One of the most interesting applications for clinicians is teleconsultation, specially nowadays with COVID pandemic. We review the possible implementation of a tele-consultation program for COPD patients, the right selection of patients, technological tools and its limitations (AU)

Medidas de protección individual y colectiva en la COVID-19 / Individual and collective protection measures in COVID-19

Las vías de transmisión del SARS-CoV-2 aún no están claras, siendo seguro su contagio por contacto y gotas. Los equipos de protección individual (EPI) deben ser utilizados de forma completa y correcta para disminuir el contagio entre los profesionales sanitarios, sin olvidar las medidas básicas de protección, prevención, aislamiento de los casos confirmados y cuarentena de sus contactos estrechos hasta determinar su diagnóstico. No hay que minimizar esfuerzos en realizar compañas publicitarias en educación sanitaria a fin de favorecer el correcto uso y adherencia de la sociedad a las medidas de prevención, destinando recursos humanos y materiales proporcionados para favorecer el control de la transmisión y romper las rutas de contagio conocidas

The routes of transmission of SARS-CoV-2 are not yet clear, being contagious by contact and drops. Personal protective equipment (PPE) must be used completely and properly to reduce contagion among healthcare professionals, without forgetting the basic measures of protection, prevention, isolation of confirmed cases and quarantine of their close contacts until their diagnosis is determined. Efforts should not be minimized in carrying out publicity campaigns in health education in order to favor the correct use and adherence of society to prevention measures, allocating human and material resources provided to favor the control of transmission and break known routes of contagion

Tratamiento endovascular percutáneo de un síndrome de vena cava superior en el postoperatorio inmediato de recambio valvular mitroaórtico / Percutaneous endovascular treatment of an iatrogenic superior cava vein syndrome during the immediate post-operative period after mitral-aortic valve replacement

El síndrome de vena cava superior (SVCS) resulta de la obstrucción de la vena cava superior, que origina una disminución del retorno venoso procedente de cabeza, cuello y extremidades superiores. Aunque la causa más frecuente siguen siendo procesos tumorales malignos, en los últimos años hemos visto un aumento de causas no tumorales, como trombosis de dispositivos intravasculares permanentes o causas iatrogénicas durante la cirugía cardiaca. Presentamos un caso de SVCS tras cirugía cardiaca tratado de forma satisfactoria mediante técnica endovascular y anticoagulación sistémica

Superior vena cava syndrome (SVCS) results from superior vena cava obstruction, causing a decrease in venous return from the head, neck, and upper extremities. Although the most frequent cause is still malignant tumour processes, in recent years an increase has been observed in non-tumour causes, such as thrombosis of intravascular devices or iatrogenic causes during cardiac surgery. A case is presented of SVCS after cardiac surgery treated satisfactorily by an endovascular technique and systemic anticoagulation

Atención y aspectos terapéuticos de la EPOC al final de la vida / Attention and therapeutic aspects of COPD at the end of life

En los últimos años, hemos asistido a un importante avance en el manejo de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), lo que ha llevado a un incremento de su supervivencia. Este hecho ha supuesto que tengamos que abordar nuevos retos a los que debemos dar respuesta, incluyendo la atención de estos enfermos al final de su vida. El problema está en la dificultad de detectar al grupo de individuos con EPOC subsidiarios de recibir un abordaje paliativo. Una de las aproximaciones clásicas para valorar la necesidad de esta aproximación es considerar que si el paciente falleciese en los próximos 12 meses no sería una sorpresa. Sin embargo, muchos autores consideran que el uso exclusivo de este criterio no es útil en los individuos con EPOC. En este sentido, se ha descrito que los cambios en ciertos parámetros a los largo del tiempo podrían ayudar a predecir mejor la mortalidad en ese periodo de tiempo. En cualquier caso, una correcta coordinación entre la consulta de EPOC, la planta de hospitalización de Neumología y la unidad de cuidados paliativos podría facilitar la toma de decisiones. En este artículo se abordan aspectos relacionados con la atención y los aspectos terapéuticos de la EPOC al final de la vida, incluyendo los criterios que ayudan a identificar a estos enfermos, los síntomas asociados a la EPOC avanzada y el abordaje de los mismos y cómo realizar el manejo terapéutico en los últimos días de vida del paciente con esta enfermedad

In recent years, we have witnessed an important advance in the management of patients with chronic obstructive pulmonary disease (COPD), which has led to an increase in their survival. This has meant that we have to address new challenges to which we must respond, including the care of these patients at the end of their lives. The problem lies in the difficulty of detecting the group of individuals with COPD that are subsidiary to receiving a palliative approach. One of the classic approaches to assess the need for this approach is to consider that if the patient died in the next 12 months it would not be a surprise. However, many authors consider that the exclusive use of this criterion is not useful in individuals with COPD. In this sense, it has been described that changes in certain parameters over time could help to better predict mortality in that period of time. In any case, a correct coordination between the COPD consultation, the Pneumology hospitalization unit and the palliative care unit could facilitate decision making. This article addresses aspects related to the care and therapeutic aspects of COPD at the end of life, including the criteria that help identify these patients, the symptoms associated with advanced COPD and the approach to them and how to perform therapeutic management in the last days of life of the patient with this disease

Percutaneous endovascular treatment of an iatrogenic superior cava vein syndrome during the immediate post-operative period after mitral-aortic valve replacement. / Tratamiento endovascular percutáneo de un síndrome de vena cava superior en el postoperatorio inmediato de recambio valvular mitroaórtico.

Superior vena cava syndrome (SVCS) results from superior vena cava obstruction, causing a decrease in venous return from the head, neck, and upper extremities. Although the most frequent cause is still malignant tumour processes, in recent years an increase has been observed in non-tumour causes, such as thrombosis of intravascular devices or iatrogenic causes during cardiac surgery. A case is presented of SVCS after cardiac surgery treated satisfactorily by an endovascular technique and systemic anticoagulation.

Prevención de lesiones cutáneas asociadas a ventilación mecánica no invasiva / Prevention of skin injuries associated with non-invasive mechanical ventilation

No disponible

Asma, rinitis y seguridad vial / Asthma, rhinitis and road safety

Introducción: Las lesiones por accidente de tráfico constituyen uno de los principales problemas de salud de la población mundial en los inicios del siglo XXI. En este estudio nos planteamos estudiar si existe una mayor prevalencia de accidentalidad en la conducción en personas con diagnóstico de asma y/o rinitis. Método: Se eligieron, de forma consecutiva durante un periodo de tres meses, a pacientes que acudieron a consultas de dos centros de Salud sin aquejar patología crónica, todos ellos con un rango de edad entre 18 y 65 años, conductores habituales y a un grupo de enfermos de las consultas de neumología, alergia y ORL de Hospital de Jerez, con diagnóstico de asma/rinitis. A estos pacientes se les entrevistó siguiendo cuestionario preestablecido, recogiéndose datos demográficos, consumo de tabaco antecedentes de siniestralidad en la conducción, características del asma y la rinitis y la escala Goldberg Anxiety-Depression (GADS) para la valoración de la existencia de comorbilidad psiquiátrica. Se calculó la prevalencia de accidentalidad en cada grupo y en los pacientes con diagnóstico de rinitis/asma, también en función de estos diagnósticos y su gravedad. Resultados: Se entrevistó a 424 personas sanas (49,3% mujeres) de 38 años de edad media y a 185 pacientes asmáticos/riníticos (52,4% mujeres), con edad media de 45 años. Un 67,6% de ellos padecían rinitis con o sin asma. Referían haber sufrido accidentes de tráfico un 33,8% del grupo control y el 41,6% de los pacientes asmáticos (p <0,001). Los pacientes que presentaban solamente rinitis (n = 125) concentraron más accidentes que la población sana del grupo control (0,48 ± 0,51 vs 0,34 ± 0,47; p < 0,001). La siniestralidad mostró relación con el grado de control del asma y la gravedad del asma y rinitis. Conclusiones: Existen indicios de una mayor siniestralidad en la conducción entre personas asmáticas y riníticas, que podría estar relacionada con la gravedad de estas patologías

Introduction: injuries from traffic accidents constitute one of the main health problems for the global population in the early 21st century. This study aims to determine if there is a greater prevalence of accident-causing driving among individuals diagnosed with asthma and/or rhinitis. Method: patients visiting two health centers who were not afflicted with chronic disease were recruited consecutively over the course of three months. All participants ranged between 18 and 65 years old, and were habitual drivers. A group of ill patients with a diagnosis of asthma/rhinitis were also recruited from the pulmonology, allergy and ENT departments at the Hospital de Jerez. These patients were interviewed following a predetermined questionnaire, collecting demographic data, tobacco use, history of driving accidents, characteristics of the asthma and rhinitis and the Goldberg Anxiety-Depression Scale (GADS) was used to evaluate the existence of a psychiatric comorbidity. The prevalence of accidents was calculated in each group and among the patients with a diagnosis of rhinitis/asthma, as well as according to diagnosis and severity. Results: 424 healthy individuals (49.3% women) were interviewed with an average age of 38. We also interviewed 185 patients with asthma/rhinitis (52.4% women), with an average age of 45. Of those interviewed, 67.6% suffered from rhinitis with or without asthma. A total of 33.8% of the control group and 41.6% of asthmatic patients (p <0.001) reported having suffered traffic accidents. Patients suffering only from rhinitis (n = 125) had more accidents than the healthy population in the control group (0.48 ± 0.51 vs 0.34 ± 0.47; p < 0.001). Accidents showed a correlation with the level of asthma control and the severity of asthma and rhinitis. Conclusions: there is a higher rate of driving accidents among individuals suffering from asthma and rhinitis, which may be related to the severity of these illnesses

Preventing facial pressure ulcers in patients under non-invasive mechanical ventilation: a randomised control trial.

OBJECTIVE: To comparatively assess the efficacy of four different therapeutic strategies to prevent the development of facial pressure ulcers (FPUs) related to the use of non-invasive mechanical ventilation (NIV) with oro-nasal masks in critically ill hospitalised patients. METHOD: This randomised control trial was performed at the high dependency unit in the University General Hospital Gregorio Marañón in Madrid, Spain. Overall, 152 patients with acute respiratory failure were recruited. All patients were hospitalised and received NIV through oro-nasal masks. The Norton tool was used to evaluate the general risk of developing pressure ulcers (PUs). Subjects were divided into four groups, each of them receiving a different treatment. Tissue assessment and preventive care were performed by a member of the research team. RESULTS: The incidence of FPUs was significantly lower in the group receiving a solution of hyperoxygenated fatty acids (HOFA) when compared with each of the other therapeutic strategies: direct mask (p=0.055), adhesive thin dressing (p=0.03) and adhesive foam dressing (p<0.001). CONCLUSION: The application of HOFA on the facial skin in contact with the oro-nasal masks showed the highest efficacy in the prevention of NIV-related FPUs.

Ecografía torácica / No disponible

Clásicamente relegada al estudio de la patología pleural, en los últimos años se han descrito numerosas aplicaciones de la ecografía en el estudio de diversas enfermedades del tórax que afectan no sólo a la pleura, sino también al pulmón, pared torácica o diafragma. Comparada con otras pruebas de imagen, la ecografía presenta importantes ventajas, entre las que se incluyen la ausencia de radiaciones ionizantes y la obtención de imágenes en tiempo real, además de su portabilidad y bajo coste. En el presente artículo, se resumen algunos aspectos técnicos básicos de la ecografía, los principales hallazgos ecográficos en el tórax normal, así como las diferentes aplicaciones de la técnica y los patrones ecográficos más comunes en patología torácica

No disponible

Punciones transtorácicas guiadas con ecografía / No disponible

La ecografía transtorácica es una técnica de gran utilidad para guiar punciones. Presenta ventajas sobre otras, como el TAC y la fluoroscopia. El mayor beneficio que el neumólogo puede encontrar en ella es la accesibilidad de la técnica y la visión en tiempo real de la aguja. Como cualquier otra, requiere de una curva de aprendizaje, que es perfectamente asumible por los neumólogos que se dedican a realizar técnicas neumológicas

No disponible

Fully automatic rhythm analysis during chest compression pauses.

AIM: Chest compression artefacts impede a reliable rhythm analysis during cardiopulmonary resuscitation (CPR). These artefacts are not present during ventilations in 30:2 CPR. The aim of this study is to prove that a fully automatic method for rhythm analysis during ventilation pauses in 30:2 CPR is reliable an accurate. METHODS: For this study 1414min of 30:2 CPR from 135 out-of-hospital cardiac arrest cases were analysed. The data contained 1942 pauses in compressions longer than 3.5s. An automatic pause detector identified the pauses using the transthoracic impedance, and a shock advice algorithm (SAA) diagnosed the rhythm during the detected pauses. The SAA analysed 3-s of the ECG during each pause for an accurate shock/no-shock decision. RESULTS: The sensitivity and PPV of the pause detector were 93.5% and 97.3%, respectively. The sensitivity and specificity of the SAA in the detected pauses were 93.8% (90% low CI, 90.0%) and 95.9% (90% low CI, 94.7%), respectively. Using the method, shocks would have been advanced in 97% of occasions. For patients in nonshockable rhythms, rhythm reassessment pauses would be avoided in 95.2% (95% CI, 91.6-98.8) of occasions, thus increasing the overall chest compression fraction (CCF). CONCLUSION: An automatic method could be used to safely analyse the rhythm during ventilation pauses. This would contribute to an early detection of refibrillation, and to increase CCF in patients with nonshockable rhythms.

Real world comparison of the MGuard Stent versus the bare metal stent for ST elevation myocardial infarction (the REWARD-MI study).

AIM: The MGuard Stent (MGS) was designed to prevent distal embolization of thrombus and has been shown to improve microcirculation in ST-elevation myocardial infarction (STEMI). However, there are no real world data comparing it with the bare metal stent (BMS). The aim of this study is to determine the efficacy and safety of the MGS in STEMI in the real world compared to the BMS. METHODS AND RESULTS: In total, 262 patients were included from a single centre, of which 35.9% had an MGS implanted. Two groups of 79 patients were established after propensity score matching, and they were similar in terms of baseline and periprocedural variables. The mean follow-up was 321 ± 12.94 days. There was no difference in mortality (7.6% in both groups), major adverse cardiac events (20.3% vs. 12.7%, P = 0.198), non-cardiac mortality, or non-fatal myocardial infarction (6.3% in both groups). Target lesion revascularization (TLR) was significantly higher in the MGS group (11.4% (9) vs. 1.3% (1) P < 0.01; RR 10.02 [1.23-81.16]). CONCLUSION: Our study is the first to compare the MGS with the BMS in STEMI in the real world, and it also appears to confirm that although the MGS is a safe device in STEMI that is not associated with increased mortality, it is associated with a higher long-term TLR rate. © 2014 Wiley Periodicals, Inc.

A reliable method for rhythm analysis during cardiopulmonary resuscitation.

Interruptions in cardiopulmonary resuscitation (CPR) compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA) designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.

Reliable extraction of the circulation component in the thoracic impedance measured by defibrillation pads.

AIM: To analyze the feasibility of extracting the circulation component from the thoracic impedance acquired by defibrillation pads. The impedance circulation component (ICC) would permit detection of pulse-generating rhythms (PRs) during the analysis intervals of an automated external defibrillator when a non-shockable rhythm with QRS complexes is detected. METHODS: A dataset of 399 segments, 165 associated with PR and 234 with pulseless electrical activity (PEA) rhythms, was extracted from out-of-hospital cardiac arrest episodes by applying a conservative criterion. Records consisted of the electrocardiogram and the thoracic impedance signals free of artifacts due to thoracic compressions and ventilations. The impedance was processed using an adaptive scheme based on a least mean square algorithm to extract the ICC. Waveform features of the ICC signal and its first derivative were used to discriminate PR from PEA rhythms. RESULTS: The segments were split into development (83 PR and 117 PEA rhythms) and testing (82 PR and 117 PEA rhythms) subsets with a mean duration of 10.6s. Three waveform features, peak-to-peak amplitude, mean power, and mean area were defined for the ICC signal and its first derivative. The discriminative power in terms of area under the curve with the testing dataset was 0.968, 0.971, and 0.969, respectively, when applied to the ICC signal, and 0.974, 0.988 and 0.988, respectively, with its first derivative. CONCLUSION: A reliable method to extract the ICC of the thoracic impedance is feasible. Waveform features of the ICC or its first derivative show a high discriminative power to differentiate PR from PEA rhythms (area under the curve higher than 0.96 for any feature).

Feasibility of automated rhythm assessment in chest compression pauses during cardiopulmonary resuscitation.

AIM: To demonstrate the feasibility of doing a reliable rhythm analysis in the chest compression pauses (e.g. pauses for two ventilations) during cardiopulmonary resuscitation (CPR). METHODS: We extracted 110 shockable and 466 nonshockable segments from 235 out-of-hospital cardiac arrest episodes. Pauses in chest compressions were already annotated in the episodes. We classified pauses as ventilation or non-ventilation pause using the transthoracic impedance. A high-temporal resolution shock advice algorithm (SAA) that gives a shock/no-shock decision in 3s was launched once for every pause longer than 3s. The sensitivity and specificity of the SAA for the analyses during the pauses were computed. RESULTS: We identified 4476 pauses, 3263 were ventilation pauses and 2183 had two ventilations. The median of the mean duration per segment of all pauses and of pauses with two ventilations were 6.1s (4.9-7.5s) and 5.1s (4.2-6.4s), respectively. A total of 91.8% of the pauses and 95.3% of the pauses with two ventilations were long enough to launch the SAA. The overall sensitivity and specificity were 95.8% (90% low one-sided CI, 94.3%) and 96.8% (CI, 96.2%), respectively. There were no significant differences between the sensitivities (P=0.84) and the specificities (P=0.18) for the ventilation and the non-ventilation pauses. CONCLUSION: Chest compression pauses are frequent and of sufficient duration to launch a high-temporal resolution SAA. During these pauses rhythm analysis was reliable. Pre-shock pauses could be minimised by analysing the rhythm during ventilation pauses when CPR is delivered at 30:2 compression:ventilation ratio.